Misc Flashcards
1
Q
Menetrier Disease. Gastric related
A
Hyperplasia of gastric (stomach) mucosa. Mainly glandular secretion of mucous and super-hypertrophied stomach rugae (look like brain gyri). Parietal cells die, subsequent achlorhydria.
Precancerous
2
Q
Mallory bodies found on liver biopsy. What are they, and what are their significance?
A
Eosinophilic inclusions of damaged keratin filaments
Found in alcoholic hepatitis
3
Q
Aspergillus causes what hepatic abnormality. Mediated by what toxin?
A
Aflatoxin from aspergillus –> hepatocellular carcinoma
4
Q
Two places in GI histology with PAS positive intracellar stuff?
A
Whipple Disease: foamy macrophages with PAS+ inclusions
Alpha-1 antitrypsin deficiency: PAS+ globules in liver
5
Q
Long-term use of proton-pump inhibitors can cause what metabolic abnormality?
A
Hypomagnesemia! Ain’t that some shit
Also increased risk for C. diff infection
6
Q
Orlistat MOA. (Hint: GI related)
A
Inhibits pancreatic and gastric lipase enzymes resulting in decreased fat absorption. Used in weight-loss treatments. Causes steatorrhea and decreased absorption of fat soluble vitamins
7
Q
Patient presents with swollen, red, and tender calf. He says he has had a couple of these throughout his body in the last few months. They usually self resolve w/o issue. Also found to have cholestatic LFTs with elevated amylase and lipase. Dx?
A
Migratory Thrombophlebitis that is strongly associated with pancreatic cancer (hence the cholestatic LFTs with elevated lipase + amylase.
8
Q
Diseases associated with the infamous HLA-B27 subtype
A
PAIR: psoriasis, anklyosing spondyolitis, IBD (UC/Crohns), Reiter syndrome (reactive arthritis)
9
Q
Patient with ADPKD presents with thunderclap headache. After successful treatment, 7 days later develops focal neurologic signs. What happened? What Rx should have been used to prevent this
A
Subarachnoid hemorrhage from ruptured berry aneurysm (associated with ADPKD). Sequelae of cerebral vasospasm occurring a few days later. Prevent with calcium channel blocker Nimodipine specificaly
10
Q
Cromolyn sodium use? (Hint: blood cells)
A
Prevents degranulation of mast cells. Used in asthma prophylaxis (apparently…)
11
Q
Hemophilia C deficiency and inheritance?
A
Autosomal recessive deficiency in factor XI.
Contrast with A & B, both X linked
12
Q
Difference in genetic defect in beta vs alpha thalassemia.
A
Alpha thalassemia has gene mutations in the gene itself. Beta thalassemia mutations are in promoter and splice site sequences
13
Q
Basophillic stipiling. What is it? Associated diseases
A
Aggregates of rRNA that can’t be degraded because of usually lead poisoning (or sideroblastic anemia)
14
Q
Distinguishing folate deficiency from B12 deficiency using labs
A
Folate: elevated homocysteine, normal methylmalonic acid
B12: elevated homocysteine & methylmalonic acid
15
Q
Eculizumab clinical indication
A
Paroxysmal nocturnal hematuria
Acts to inhibit terminal activation of complement
16
Q
Ristocetin (old antibiotic, no longer used for Rx humans). Usefulness as a lab test?
A
Ristocetin causes binding between GpIb and vWF resulting in agglutination
+Ristocetin test in Glanzmann thrombasthenia (defective GpIIb/IIIa)
-Ristocetin test in Bernard-Soulier syndrome (Defective GpIb)
17
Q
TdT+ marker (flow cytometry). Significance?
A
Marker of early T and B cells. Think of Acute lymphocytic leukemia (in children)
18
Q
t(8;14)
A
c-myc(8) and Ig heavy chain(14)
Burkitt’s lymphoma
19
Q
t(9;22)
A
BCR(22) and Abl(9)
Chronic myelogenous leukemia (Rx: Imatinib)
20
Q
t(11;14)
A
Cyclin D1(11) and Ig heavy chain(14) Mantle cell lymphoma
21
Q
t(14;18)
A
BCL-2(18) and Ig heavy chain(14)
Follicular lymphoma
22
Q
t(15;17)
A
M3 subtype of AML that responds to all-trans retinoic acid
23
Q
Most common type of non-Hodgkin lymphoma in adults?
A
Diffuse large B-cell lymphoma
24
Q
JAK2 mutation associated with what blood abnormality
A
Myeloproliferative disorders: polycythemia vera, essential thrombocytosis, myelofibrosis
25
Aminocaproic acid. Antidote for what?
Thrombolytics. Aminocaproic acid acts to inhibit fibrinolysis
26
Abciximab, eptifibatide, tirofiban. Drugs used for what? (Hint: heme/onc)
Inhibitors of GpIIb/IIIa receptor, thus decrease platelet aggregation
27
Etoposide, teniposide | irinotecan, topotecan MOA? (Hint: Heme/Onc)
Etoposide, teniposide: Inhibit topoisomerase II preventing appropriate DNA replication. Used as an anti-neoplastic drug.
Irinotecan, topotecan: inhibit topoisomerase I
28
Rituximab MOA
Monoclonal Ab against CD20. Used against B-cell neoplasms (think CLL, B-type)
29
Bevacizumab MOA
Monoclonal antibody against VEGF, inhibits angiogenesis. AKA - Avastin
30
Both Alports and Marfans have vision issues. What's the difference?
Alports (collagen type IV defect) gets cataracts because the collagen within the lens itself is type IV.
Marfans (fibrilin1 defect) gets lens ectopy/displacement because fibrilin is an important component of the zonules that hold the lens in place.
31
Cilostazol & dipyridamole MOA and indications? (Hint: Heme/onc)
Both are PDE inhibitors used in treatment of peripheral arterial disease. Increased cAMP inhibits platelet aggregation and increased cGMP causes vasodilation
32
Anti-inflammatory cytokines
IL-10 (attenuate immune system) and TGF-beta
33
Costimulatory signal for T-cell and B-cell activation?
T-cell: CD28 on T-cell activated by B7 on APC
| B-cell: CD40 on B-cell activated by CD40L on T-cell
34
Embryologic origin of anterior vs posterior pituitary
Anterior (adenohypophysis) derived from oral ectoderm (rathke's pouch)
Posterior (neurohypophysis) derived from neuroectoderm
35
Significance of Ras/MAP kinase pathway (Hint: endocrine)
Activated by insulin tyrosine kinase receptors. Stimulates cell growth & DNA synthesis
36
GLUT-2 significance
Insulin independent, bidirectional movement of glucose. Found in beta-islet cells, liver, kidney, & small intestine
37
MSH (melanotropin stimulating hormone). Origin, significance
Secreted from intermediate lobe of pituitary, but also stimulated by CRH (just like ACTH)
38
Grehlin hormone. Origin, effect
Released by stomach. Stimulates hunger. Elevated in Prader-Willi syndrome
39
Difference b/w cortisol and thyroid hormone effects on cells?
Cortisol: upregulation of alpha1 receptors on arterioles
Thyroid: upregulation of beta1 receptors on heart
40
Difference b/w methimazole and Propylthiouracil
Methimazole inhibits peroxidase
| PTU inhibits peroxidase & 5-deiodinase
41
Striae seen in cushings syndrome caused by what
Cortisol suppresses fibroblast activity in the skin, resulting in characteristic striae
42
Metyrapone test (hint: endocrine)
Test for adrenal insufficiency. Metyraprone inhibits final step of cortisol synthesis (11-deoxycortisol-->cortisol). If ACTH remains low, this suggests adrenal insufficiency
43
Homer-wright rosettes characteristic of what (Hint: endocrine)
Histology finding characteristic of pediatric neuroblastoma (located in adrenal medulla or anywhere on sympathetic chain)
Bombesin & neuron-specific enolase +. N-myc oncogene overexpression
44
Patient with facial/periorbital edema, hypercholesterolemia, and an abnormal TSH. Dx?
Hypothyroidism. Low TSH. Thyroid hormone stimulates LDL receptor expression. When T3/T4 is low, LDLr decreases, hypercholesterolemia occurs. Remeber the edema too
45
Rx for thyroid storm
Propanolol, propylthiouracil, prednisolone
46
Most common kind of thyroid cancer
Papillary (Psammoma bodies)
47
Diabetic patient started on a new drug complains that he started feeling really sick after drinking just a little alcohol. What's going on?
Disulfram-like effects seen in 1st generation sulfonylureas (chlorpropamide, tolbutamide).
Disulfram inhibits acetylaldehyde dehydrogenase
48
Diabetic patient recently started on a new drug. He has fractured two bones since. Previously perfectly healthy individual. What's going on?
Glitazones (e.g. pioglitazone) increase risk of fractures. Also increase hepatotoxicity
49
Demeclocycline MOA
ADH antagonist. Used in Rx of SIADH
50
Cinacalcet MOA
Sensitizes CaSR (Calcium sensing receptor) in parathyroid gland: decreases PTH secretion
51
Treatment for leprosy
Lepromatous form: DRC (Dapsone, rifampin, clofazimine)
| Tuberculoid form: Dapsone and rifampin
52
Liver biopsy of patient reveals intracellular globules that stain a purple-pinkish color on PAS stain. DIagnosis?
Alpha-1 antitrypsin deficiency. PAS stains accumulated A1antitrypsin molecules (misfolded proteins due to mutation)
53
Flutamide & cyproterone. Prescribed to a patient with prostate cancer
Both compete with testosterone and DHT for testosterone receptors.
54
Most common pathogens in aspiration pneumonia
Fusobacterium, peptostreptococcus, bacteroides
55
Neostigmine, MOA
Acetylcholine esterase inhibitor. Used to reverse neuromuscular blockade post-operatively. No CNS penetration (neither does pyridostigmine)
56
Patient has been eating seafood, then complains of "cold feels hot, and hot feels cold." Dx?
Ciguatoxin poisoning from reef fish (e.g. barracuda, snapper, moray eel). Tonic opening of Na channels (similar clinical picture to cholinergic poisoning)
57
Isoproterenol MOA
Beta1 and beta2 agonist
58
Norepinephrine MOA and effect on HR
NE: alpha1, alpha2, (some beta1)
| Causes reflex bradycardia from dramatic increase in MAP. Beta1 effects are not really felt
59
Good choice of antidepressant in anorexic patient?
Mirtazapine (centrally acting alpha2 antagonist). Increases appetite!
60
Selectivity of class II antiarrhythmics
Non-selective alpha & beta antagonists: Carvedilol, labetalol
Beta1 antag selective:(A-M) acebutolol, atenolol, betaxolol, esmolol, metoprolol
Beta1, Beta2 antag: (N-Z) nadolol, pindolol, propranolol, timolol
61
Clinical diagnosis of narcolepsy (lab test)?
Decreased CSF levels of hypocretin-1: normally secreted by the lateral hypothalamus, involved in maintaining wakefulness
62
Kidney stones that are not radio-opaque?
Uric acid stones. All others are radiopaque (hence the utility of KUB). Calcium oxalate or phosphate, Struvite (Mg ammonium sulfate, triple phosphate), and cystine are all radiopaque
63
Strange (but important) side effect of hydrochlorothiazide?
Can cause hyperglycemia. Would really suck in a diabetic patient. MOA unknown
64
Drugs known to cause seizures (or decrease seizure threshold)
Bupropion, Isoniazid, Imipenem/cilastatin, Enflurane
65
Auscultation in the left lateral decubitus position under full exhalation best for what murmur?
Mitral stenosis (think of rheumatic heart disease). NTBCw/ S4 which is also heard best in L lateral decub
66
Specific gravity for diagnosis of diabetes insipidus (i.e. from Lithium toxicity)
Less than 1.006 is diagnostic
67
Hallmark of ischemic injury based on electrolytes?
Accumulation of intracellular Ca. Also K leaks out of cells, but intracellular Ca is pathognomonic
68
U-waves on EKG? Progression to?
Hypokalemia which can cause progression to torsades de pointes
69
Innervation of Teres Minor
Axillary nerve
| Teres minor is one of rotator cuff muscles
70
Blood supply and drainage of rectum
Superior rectal artery comes off of IMA. Middle rectal artery from internal iliac artery, and inferior rectal from internal pudendal artery
Superior rectal vein drains into IMV (portal), Middle rectal vein -> internal iliac vein, and inferior rectal vein -> internal pudendal vein.
*Note that only superior rectal vein and artery are part of portal system
71
Jones methenamine silver stain in a patient with >3.5g protein loss/day
Membranous nephropathy, nephrotic syndrome. Most common cause of nephrotic syndrome in adults.
Remember the stain name! Will show thickened basement membrane
72
Hydrophobic amino acids. (Think of 7transmembrane alpha helices)
LIVAPP TransMembrane G
| Leucine, isoleucine, valine, alanine, phenylalanine, proline. Tryptophan, methionine, glycine
73
NF-1 pathophys of skin fibromas
Disorganized proliferation of schwann cells. Remember Lisch nodules (iris hamartomas) as well
74
Niacin (for increasing HDL) causes flushing by what mechanism
Increased production of prostaglandin D2 causing skin vasodilation. Pretreat with aspirin (COX) to prevent this.
75
Drug eluting stents (for MIs) use what drugs and what MOA?
Paclitaxel (beta-tubulin stabilizer) & sirolimus (mTOR inhibitor). Both prevent intimal hyperplasia which causes restenosis and thrombosis. Inflammation is not the target!
76
Difference between lysyl hydroxylase and lysyl oxidase in collagen synthesis
Lysyl hydroxylase adds OH groups to lysine residues on procollagen in the rough ER just before triple helix formation.
Lysyl oxidase forms covalent bonds between collagen helices in the extracellular matrix (after transpeptidase cleavage, also in extracellular matrix)
77
Mutation in glucokinase causes what?
Maturity onset diabetes of the young. Glucokinase found in hepatic and pancreatic cells. Mutation essentially increases serum glucose set point for insulin release.
78
Hypernatremic patient presents with very dilute urine. CXR reveals a lung nodule. He's been smoking for 50+yrs. Dx? Be careful here.
Diabetes insipidus precipitated by hypercalcemia in a patient with squamous cell carcinoma. PTHrP causes hypercalcemia which directly downregulates expression of aquaporins in the collecting tubules
79
What's the story with Clopidogrel taken with grapefruit juice?
Grapefruit juice is a P450 inhibitor and clopidogrel (ADP receptor antag) depends on P450 for activation (not metabolism!). Thus clopidogrel effectiveness will be decreased
80
Baclofen MOA
Agonist of GABAb receptors in the spinal chord mostly: subsequent relaxation of muscles (Rx for spasticity)
81
Middle trunk of brachial plexus composed of what
C7 nerve root on it's own. Note that upper trunk is C5, C6 combined (Erb's palsy), lower trunk is C8, T1 combined (Klumpke palsy)
82
Dorsal and palmar interossei muscles of the hand. Innervation and action.
PAD and DAB. Palmar adduct, dorsal abduct. Makes intuitive sense if looking at hand. All innervated by ulnar. (Lateral lumbricals innervated by median)
83
Traction on upper trunk of brachial plexus causes deficits to all proximal shoulder muscles except?
Teres minor (axillary nerve innervation). All the rest of the rotator cuff muscles, deltoid, and biceps are down (Erb's palsy/Waiter's tip)
84
I band in sarcomere
Straddles the Z line, bordered by end of thick filaments on both sides.
85
T-tubule anatomy difference between cardiac and skeletal muscle
Skeletal muscle: each T tubule associated with 2 terminal cisternae (ends of SR with ryanodine receptors)
Cardiac muscle: each T tubule associated with only 1 terminal cisternae
86
Other than nephrogenic diabetes insipidus, what is Lithium highly associated with?
Hypothyroidism (weight gain, dry skin, constipation)
87
Koilocytes associated with what?
HPV infection of the cervix. Found on cervical smear. Represent immature squamous cells with dense, irregular cytoplasm (UWorld#28.17)
88
Patient with puritis after hot showers. Diagnosis?
Polycythemia vera from JAK2 mutation causing increased sensitivity to growth factors (bone marrow)
89
Phencyclidine MOA
PCP. NMDA receptor antagonist that causes violent aggressive people with nystagmus
90
Mature form of bone?
Lamellar bone
91
Denosumab MOA
monoclonal antibody against RANKL receptor. Used in treatment of osteoporosis (type II, senile) to decrease osteoclast activity
92
Anti-cyclic citrullinated peptide antibody
Most specific for rheumatoid arthritis. Rheumatoid factor is non-specific
93
Skin layer where desmosomes are located? Components of desmosomes & pathophysiology?
Stratum spinosum. Desomsomes contain desmoplankin, desmoglein, and keratin filaments. Associated with pemphigus vulgaris
94
Blistering skin disorders and nikolsky's sign
Nikolsky sign positive when manual stroking of the skin causes separation of dermis. Positive in pemphigus vulgaris (anti-desmoglein IgG in stratum spinosum). Negative in bullous pemphigoid (anti-hemidesmosome Abx)...this is hella counterintuitive
95
Histopathology pathognomonic for squamous cell carcinoma
Keratin pearls (P443 pic)
96
Alendronate MOA and toxicities (2)
Bisphosphante. MOA: binds hydroxyapatite in bone which prevents osteoclastic resorption of bone.
Toxicities: Corrosive esophagitis (drink with water, remain upright for 30mins), osteonecrosis of jaw
97
Non-adrenergic Gs receptors and ultimate phosphrylation step
Glucagon, FSH, TH, PTH
| Ultimately results in protein kinase A phosphorylating serine or threonine residues on downstream enzymes
98
Lomotil MOA
Diphenoxylate + atropine. Used as an anti-diarrheal agent. Diphenoxylate is a mu opiod receptor agonist in the GI tract which slows gastric motility. Atropine is thrown in there to fuck with people who want to abuse the drug. Higher doses of the drug cause anti-cholinergic effects, lol hilarious!
99
MOA of niacin for dyslipidemia
Decreased synthesis of VLDL and triglycerides by hepatocytes
100
Calculating half life of a drug
(Vd*0.7)/Clearance
101
Two ways in which kidney responds to a metabolic acidosis (i.e. DKA)
Increase reabsorption of HCO3, secrete NH3 and HPO4(2-) both of which are titratable acids that allow trapping of H+ in the urine for removal
102
Timeframe for diagnosis of postpartum depression
Occurs >2weeks post-partum
103
Tartrate resistant acid phosphatase
Present in activated monocytes and osteclasts (multinucleated cells!)
104
Patient presents with coalescing erythematous lesions with crusting and scaling. Central areas of bronze-colored induration. New onset diabetes mellitus. Dx?
Glucogonoma manifesting as necrolytic migratory erythema
105
Positive skew of data, effect on mean, median, mode
Tail extends in the positive direction. Has strongest effect on mean > median > mode
106
How to fix proptosis in graves opthalmolopathy
High dose steroids only. Note that correcting hypothyroidism (or giving propanolol) does not fix inflammation causing opthalmopathy
107
Most important risk factor for development of metastases in melanoma
Breslow thickness. Vertical growth/depth of invasion on histology. (Not cellular atypia)
108
Receptors known to "trimerize"
Fas receptors which mediate apoptosis in response to FasL. May be mutated in lupus: growth of auto-reactive lymphocytes
109
Two most common causes of body fat redistribution syndrome
Glucocorticoids and HIV protease inhibitors
110
First gen antipsychotics. Low potency: Chlorpromazine, thioridiazine vs. High potency: haloperidol, fluphenazine. Difference in side effect profile?
Low potency tend to cause sedation, anticholinergic, and anti alpha-adrenergic (orthostatic hypotension) effects. High potency tend to cause extrapyramidal symptoms
111
Neonate born 24hrs ago begins to exhibit rhinorrhea, diarrhea, sneezing, vomiting that eventually progresses to seizures. Dx? Rx?
Neonate opioid (e.g. heroin, etc) withdrawal. Rx with tincture of opium and slowly titrate off
112
Hirschprung disease pathophysiology. Be very specific here.
Failure of migration of neural crest cells into both the meissner (submucosal) and auerbach (myenteric) plexi of the bowel wall. Recum always involved. Dx with biopsy of submucosal layer
113
75yo patient with recurrent hemorrhagic strokes of the cerebral cortex. Dx?
Cerebral amyloid angioapathy. Occurs in elderly people. No association with systemic amyloidosis. Amyloid deposits in vascular walls causing recurrent strokes in the cortex!
114
Patient with hepatosplenomegaly, spider angiomatas, gynecomastia, and asterixis also has malodorous breath. Cause?
Ammonia accumulation from lack of liver ability to create urea from ammonia causes bad breath and body odor
115
Hyper-estrogenism in cirrhotics. Mechanisms (2)?
Decreased metabolism of estrogen by liver. Accumulation of sex hormone binding globulin which preferentially binds testosterone over estrogen
116
Most common site for colon cancer.
Recto-sigmoid colon. Descending colon lesions are most likely to obstruct while ascending lesions are most likely to bleed
117
Define imprinting in relationship to Prader-Willi
Chromosome 15 gene is maternally imprinted (meaning inactivated) in all people. Prader-Willi patients also have deleted paternal copy of chromosome 15 gene, thus resulting in no gene expression. Hyperphagia, obesity, retardation, hypotonia, etc
118
Osler-Weber-Rendu syndreom
Hereditary hemorrhagic telangiectasia. Autosomal dominant disorder manifesting with recurrent epistaxis, GI bleed, AVMs, and telangiectasias
119
MOA of opioids and other mu receptor agonists
Increased potassium efflux in cells and inhibition of calcium influx (think neurotransmitter release)
120
Hepatitis B infection in a pregnant mother transmitted to infant (usually on birth canal passage). Likelihood of developing acute, chronic, and HCC symptoms in the infant?
Neonates (poorly developed immune systems) are less likely to develop acute symptoms, but much more likely (90%) to develop chronic HepB and hepatocellular carcinoma
121
Congenital adrenal hyperplasia from 21-hydroxylase and aromatase deficiency in-utero present very similarly. How do you differentiate?
Maternal virilization only occurs in aromatase deficiency. Elevated androgens in CAH don't spill over into maternal circulation because placenta (derived from fetus embryo) has intact aromatase
122
What is Schilling Test (Hint: GI issue)
Test for pernicious anemia (B12 absorption). Patient given radioactive B12 orally then an intramuscular injection of normal B12. If gut absorption is working then radioactive B12 will be absorbed but not bound in the liver (saturated from B12 injection) and thus will appear in the urine. At least 10% of radioactive iodine should appear in the urine
123
14yo patient gets pregnant wants an abortion. What do you do.
2/3 of states require parental consent prior to abortion, 1/3 require parental notification but not consent. No parental consent needed for prenatal care, substance abuse, or STD treatment in minors
124
Manifestations of Henoch-Schonlein purpura (4)
Occurs in children after an URI (viral or streptococcal). All are mediated by IgA immune complex deposition
1) Skin: palpable purpura
2) Kidneys: IgA nephropathy-like picture
3) Joints: migratory arthralgias of large joints
4) GI: Abdominal pain, bloody stools, increased risk for intussusception
125
Auscultation of murmurs associated with ASD and VSD
Left lower sternal border. ASD murmur actually comes from increased flow through pulmonic valve, not from the defect itself. Not true of VSDs though
126
Receptors on parietal cells in gastric mucosa
H1 (Gq) and M3 (Gs)
127
Function of Bcl-2 and pathogenesis significance
Bcl-2 inhibits apoptosis by inhibiting pro-apoptotic Apaf-1 (normally activates caspases). Bcl-2 overexpressed in follicular lymphoma
128
Three examples of liquefactive necrosis types
Brain infarcts, bacterial abscesses, and gangrenous (wet) necrosis
129
Function of caspases
Initiate apoptosis by increasing permeability of mitochondrial membranes (release of cytochrome C)
130
Karyorrhexis defined
Nuclear fragmentation that occurs in apoptosis
131
Chromatolysis defined
After axonal injury: Neuron cell swelling, displacement of nucleus to periphery, dispersion of Nissl substance throughout cytoplasm as neuron increases protein synthesis in attempt to repair itself
132
Leukocyte extravasation occurs where in vascular system
Post-capillary venules
133
Leukocyte adhesion deficiency type 1 and type 2
Type1: CD18 integrin necessary for tight binding in leukocyte extravasation process
Type2: Sialyl-Lewis necessary for margination/rolling in extravasation process
134
Diapedesis defined and mediated by? (Hint: blood cells)
Leukocytes squeezing in between endothelial cells (final step in leukocyte extravasation process). Mediated by PECAM-1 (CD31) on both WBC and endothelial cell
135
Congo red stain for what
Amyloidosis
136
P-glycoprotein significance
Multidrug resistance protein 1 (MDR1). Associated most with adrenal cell carcinoma and many other cancers. Pumps chemotherapeutic agents out of the cell
137
Dermal biopsy reveals large cells at the dermal-epidermal junction that fuse to form nests. Cells show marked atypia and hyperchromasia. Dx?
Dysplastic nevus. Increased risk for melanoma
138
BRAF gene associated with what
Serine/Threonine kinase oncogene associated with GOF mutations causing melanoma & non-Hodgkin lymphoma
139
Paraneoplastic syndrome of polycythemia can be associated with what neoplasms (5)
Renal cell carcinoma, pheochromocytoma, hepatocellular carcinoma, hemangioblastoma, leiomyoma
140
Aldolase B defiency
Congenital fructose intolerance
141
Hydrochlorothiazide is actually a really shit drug for patients with metabolic syndrome. Why?
Causes hyperglycemia, hyperlipidemia. Can also cause hyperuricemia and precipitate a gout attack
142
Myxomatous degeneration of mitral valve results in what problem and subsequent sequelae
Mitral valve prolapse which increases risk for bacterial endocarditis
143
Mental retardation in child with "mousy" odor
Phenylketonuria caused by deficiency in phenylalanine hydroxylase (autosomal recessive)
144
Difference between odds ratio and relative risk
OR in case-control study (disease vs. cases; look for associated risk factors)
RR in cohort studies (exposure then ask likelihood of developing disease)
145
Relationship between odds ratio and relative risk
When prevalence of disease is low OR = RR
146
Genetic disorder with congential hypersensitivity to ionizing radiation and skin manifestations.
Ataxia-telangiectasia syndrome
| Cerebellar atrophy, telangiectasias occur
147
Ketamine MOA
Blocks NMDA receptors (Glutamate in the neurotrans here)
148
Osteoprotogerin (OPG)
Secreted by osteoclasts and acts as a decoy receptor for RANK-L thus decreasing osteoclastic activity even in the presence of lots of RANK-L
149
Embryology of veins. 3 sources
1) Vitelline veins develop into portal circulation (think of vitelline duct -Meckels). 2) Cardinal veins develop into systemic veins 3) Umbilical veins degenerate
150
PDE inhibitor isoenzymes and their effect
Milrinone (PDE-3 inhib) increased cAMP in cardiac muscle resulting in inotropy from increased Ca.
Sildenafil (PDE-5 inhib) increased cGMP in corpus cavernosum resulting in erection maintained
151
Spingomyelinase deficiency in what disease
Neimann-Pick. NTBCw/ Tay-Sachs disease: deficiency in hexosaminididase A with ganglioside accumulation
152
Leukemia associated with retinoic acid receptor alpha (RAR-alpha) and associated translocation
Acute promyelocitic leukemia (M3 type of AML) with t(15,17) translocation. Can be treated with all trans retinoic acid to stimulate maturation of the blast cells
153
Colchicine affects blood cells specifically of what type
Neutrophils (think of gout)
154
Where are lipids absorbed in the intestine
Jejunum! NTBCw/ enterohepatic circulation of bile salts via the ileum
155
Mesna and amifostine used for what (Hint: combined with another drug)
Mesna used to prevent hemorrhagic cystitis in patients taking cyclophosphamide.
Amifostine used with cisplatin to decrease nephrotoxicity and dry mouth
156
Integrins mediate cell adhesion to basement membranes and extracellular matrix via what
Fibronectin, laminin, and collagen
157
Pathologies associated with liver zone III damage
Zone III is closest to central vein (centrilobular) - Alcoholic hepatitis, ischemia, metabolic toxins. Also is the site of p450 enzymes
158
Keratin nests and pearls on histology
Indicative of squamous cell carcinoma of various origins
159
Hirudin, lepirudin, argatroban examples of what
Direct thrombin inhibitors. These are indicated after heparin induced thrombocytopenia (HIT)
160
Dipyridamole & cilostazol MOA and indications
Both are PDE inhibitors used in preventing platelet aggregation. NTBCw/ disopryamide (class IA antiarrhythmic)
161
Smudge cells on peripheral smear
CLL (usually B cells)
